斜外侧腰椎间融合术(OLIF)并发症的临床分析

Clinical analysis of the complications of oblique lateral interbody fusion(OLIF)

目的探讨斜外侧腰椎间融合术(oblique lateral interbody fusion,OLIF)并发症的发生原因及防治策略。方法回顾性分析四川省人民医院神经外科2014年12月到2016年12月间收治的67例采用OLIF治疗的各类腰椎疾病患者的病历资料,其中联合后路经皮椎弓根螺钉固定术18例,联合前路单侧椎体螺钉内固定术26例,未行钉棒系统固定者23例。统计各类手术术中及术后并发症,探讨并发症发生的相关因素。结果 67例接受OLIF手术的患者共发生各类并发症15例,发生率22.4%。术中并发症5例,包括Cage位置不良2例;手术侧大腿短暂麻木无力2例、交感神经丛损伤1例。术中无腹腔大血管损伤、输尿管损伤等严重并发症发生。术后并发症10例,包括Cage沉降7例;手术切口脂肪液化2例,切口疝1例。术后无椎间隙及腹膜后感染等并发症发生。结论 OLIF是治疗腰椎退行性病变等疾患的一种安全有效的微创术式,并发症的发生率与适应症的选择、术者的手术技巧密切相关。

Objective The risk factors and prevention strategy of complications of oblique lateral interbody fusion （OLIF） were discussed. Methods The clinical data of 67 cases of lumbar diseases treated with OLIF in the Neurosurgical Department of Sichuan Provincial People ＇s Hospital from December 2014 to December 2016 were analyzed retrospectively. Percutaneous pedicle screws or anterior vertebral screws were used for fixation in 18 and 26 cases respectively. OLIF stand alone was used in 23 cases. All of the intra-operative and post-operative complications were recorded. Results Fifteen complications were recorded with an occurrence rate of 22. 4%. Five cases with intra-operative complications included malpositioning of the Cage in 2 cases, transient thigh numbness and weakness in 2 cases and sympathetic chain injuries in 1 case. There was no intra-operative major vascular injury and ureteral injuries. There were 10 post-operative complications including Cage subsidence in 7 cases; fat liquefaction of incision in 2 cases; there was no surgical site infection. Conclusion OLIF is a safe minimally invasive surgical approach for the treatment of lumbar degenerative diseases. Strict patient selection and sophisticated surgical skills are the keys to lower the complication rate.